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Prokinetic Antiemetic (Peripheral Dopamine Antagonist) Pregnancy: Caution — limited human data; systemic absorption may occur. Use only if benefit clearly outweighs risk.

Domperidone

Brand names: Motilium

Adult dose

Dose: 10mg up to TDS before meals and at bedtime. Maximum treatment duration: 1 week.
Route: Oral
Frequency: Up to three times daily (before meals)
Max: 30mg/day; 10mg per dose
MHRA restriction (2014): maximum 10mg TDS, maximum 1 week duration. Contraindicated in patients with cardiac conditions or risk factors for QT prolongation. Contraindicated in patients >60 years with hepatic impairment. Acts peripherally — does not cross BBB (unlike metoclopramide). Used for nausea/vomiting and gastroparesis.

Paediatric dose

Dose: 0.25 mg/kg
Route: Oral
Frequency: Up to three times daily (before meals)
Max: 10mg per dose; 0.75mg/kg/day
BNF for Children: <35kg: 0.25mg/kg up to TDS (max 0.75mg/kg/day); ≥35kg: 10mg up to TDS. Not licensed in children <12 years for nausea/vomiting without specialist supervision. Max 1 week. Source: BNF for Children 2024.

Dose adjustments

Renal

Reduce frequency to once or twice daily in moderate–severe renal impairment.

Hepatic

Contraindicated in moderate–severe hepatic impairment (increased systemic exposure — QT risk).

Paediatric weight-based calculator

BNF for Children: <35kg: 0.25mg/kg up to TDS (max 0.75mg/kg/day); ≥35kg: 10mg up to TDS. Not licensed in children <12 years for nausea/vomiting without specialist supervision. Max 1 week. Source: BNF for Children 2024.

Clinical pearls

  • MHRA 2014 review: QT prolongation and cardiac arrhythmia risk — restrict to short courses (max 1 week) at 10mg TDS. Especially avoid in those >60 years or with cardiac disease.
  • Preferred prokinetic in Parkinson's disease — does not cross BBB, so does not worsen motor symptoms (unlike metoclopramide).
  • Use for gastroparesis (e.g., in diabetic patients) — stimulates antral contractions and pyloric relaxation.
  • Domperidone raises prolactin: may be used off-label to stimulate lactation, but cardiac risks must be considered.

Contraindications

  • QT prolongation (congenital or drug-induced)
  • Concomitant QT-prolonging drugs (e.g., erythromycin, fluconazole, amiodarone)
  • Concomitant strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir — increase domperidone levels markedly)
  • Moderate–severe hepatic impairment
  • Prolactin-secreting tumour (dopamine antagonism raises prolactin)

Side effects

  • QT interval prolongation (increased risk of ventricular arrhythmia — key safety concern)
  • Hyperprolactinaemia (galactorrhoea, menstrual disturbances, gynaecomastia)
  • Dry mouth, headache
  • Extrapyramidal reactions (rare — peripheral action minimises CNS effects)

Interactions

  • Strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin, erythromycin): markedly increase domperidone plasma levels — contraindicated combination
  • QT-prolonging drugs (amiodarone, antipsychotics, fluoroquinolones): additive QT prolongation
  • Anticholinergic drugs: antagonise prokinetic effect

Monitoring

  • ECG before and during treatment (QTc)
  • Symptom response
  • Prolactin (if long-term — though duration is now restricted)

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2014 (Domperidone); SPC Motilium. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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